Chollet P, Amat S, Cure H, de Latour M, Le Bouedec G, Mouret-Reynier M-A, Ferriere J-P, Achard J-L, Dauplat J, Penault-Llorca F
Centre Jean Perrin, Bureau de Recherche Clinique, 58 Rue Montalembert, B.P.392, 63011 Clermont-Ferrand Cedex 1, France.
Br J Cancer. 2002 Apr 8;86(7):1041-6. doi: 10.1038/sj.bjc.6600210.
Only a few papers have been published concerning the incidence and outcome of patients with a pathological complete response after cytotoxic treatment in breast cancer. The purpose of this retrospective study was to assess the outcome of patients found to have a pathological complete response in both the breast and axillary lymph nodes after neoadjuvant chemotherapy for operable breast cancer. Our goal was also to determine whether the residual pathological size of the tumour in breast could be correlated with pathological node status. Between 1982 and 2000, 451 consecutive patients were registered into five prospective phase II trials. After six cycles, 396 patients underwent surgery with axillary dissection for 277 patients (69.9%). Pathological response was evaluated according to the Chevallier's classification. At a median follow-up of 8 years, survival was analysed as a function of pathological response. A pathological complete response rate was obtained in 60 patients (15.2%) after induction chemotherapy. Breast tumour persistence was significantly related to positive axillary nodes (P=5.10(-6)). At 15 years, overall survival and disease-free survival rates were significantly higher in the group who had a pathological complete response than in the group who had less than a pathological complete response (P=0.047 and P=0.024, respectively). In the absence of pathological complete response and furthermore when there is a notable remaining pathological disease, axillary dissection is still important to determine a major prognostic factor and subsequently, a second non cross resistant adjuvant regimen or high dose chemotherapy could lead to a survival benefit.
仅有少数几篇论文发表，内容涉及乳腺癌细胞毒性治疗后病理完全缓解患者的发生率及预后情况。本回顾性研究的目的是评估可手术乳腺癌新辅助化疗后乳腺及腋窝淋巴结均达到病理完全缓解患者的预后。我们的目标还包括确定乳腺中肿瘤的残余病理大小是否与病理淋巴结状态相关。1982年至2000年期间，451例连续患者被纳入五项前瞻性II期试验。六个周期后，396例患者接受了手术，其中277例（69.9%）进行了腋窝淋巴结清扫。病理反应根据谢瓦利埃分类法进行评估。在中位随访8年时，根据病理反应分析生存率。诱导化疗后60例患者（15.2%）获得了病理完全缓解率。乳腺肿瘤持续存在与腋窝淋巴结阳性显著相关（P = 5.10(-6)）。15年时，病理完全缓解组的总生存率和无病生存率显著高于病理完全缓解程度较低的组（分别为P = 0.047和P = 0.024）。在不存在病理完全缓解且此外存在明显残余病理疾病的情况下，腋窝淋巴结清扫对于确定主要预后因素仍然很重要，随后，第二种非交叉耐药辅助方案或高剂量化疗可能带来生存益处。
